Healthcare Provider Details

I. General information

NPI: 1134409204
Provider Name (Legal Business Name): MERVIN REID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 ORANGE DR SUITE 219
DAVIE FL
33330-4341
US

IV. Provider business mailing address

6720 NW 20TH ST
MARGATE FL
33063-2104
US

V. Phone/Fax

Practice location:
  • Phone: 954-862-1707
  • Fax:
Mailing address:
  • Phone: 954-803-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: